0209-191 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that Lam licensed Under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 a'tne Bu mess°'and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
C, 1165 12 8 C53 141C .31.1102
Date Signature of Contractor
OWNER -BUILDER DECLARATION,.
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code). '
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
( ) I am exempt under Section , B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
( ) I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
(11).J have and will maintain workers' compensation insurance, as required by
Secion 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier WrATE CCpLPM:ATI Policy No. 046'M138-01
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 37 0 f the Labor
Code, I shall forthwith comply with those provisions.
Date: ,f`s , :t • Applicant-
Warning:
pplicant Warning: Failure to secure Workers' Compensation coverage is unla
shall subject an employer to criminal penalties and civil fines up to $10 in
addition to the cost of compensation, damages as provided for in Sect 3 06
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building a Sa etyCl
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to,.& shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of `issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of. this City to enter upon`
the above-mentioned property for"inspection purposes'
Signature (Owner/Agent) . r! r' k''" �f5 Date V-
' PERMIT #
BUILDINGPERMIT,; ,.
`DATE', VALUATION T LOTS � � TRACT 'Wi
JOB SITE g� +C�
'ADDRESS%1-�. �YV AAbYVh1LYr
APN
.. .. .
OWNER
CONTRACTOR / DESIGNER / EN (NEER
}3lul iyaWMIS
Cl+,L1T''uRlia POOLS & sT u 0 ° y)1? .'MP a co
60� 51 R id 1Am9 o1 -,F
86.100 AVn- TU 54
LP,. QUENT.A CA 92253
COACMI `� L,A CA, 0121.16
(760):;96.92,22 CD1 00355
USE OF PERMIT
POOLvarl) OR.12TA
SPAS,, .88Q .k;LAR. .415AF RI-EILS S.RALf, BX IN
PL AC R AT 1Pf1F-F'I A So rER !NSPjt..�VOW, V?,QUIP Jf EN T 9110E02URE MCI
t OOL A9L71OR SPA 30,000.Cc4' L's
a
4•d('
EgMA `I4 COST Or- CO.NSWIRM011
LD�OTf)€9:tlil
PLAN CHWK T=EE 101-000-439-318 €74,05
CONSTRUCTION It'btala 101.000-418-000 $11100
MECHANICAL PRE a- P .SOL, )01-000-01-000
Z1..3?,C:'PR1C, 1L'ar,(r; %i PQ0L �! .14 -MV -4211)=000" 3.?
e
P 2 5 2002 iD
OF LA QUINTA
NANCE DEPT.
SUB -I.'' AT Ot.�'fk�MITL`fgZION AND i}L41 CH C:K
TOTAL PLUMITEENDUC, NOW
..c
RECEIPT
DATE/ / ��
BY '�. , �- _
DATE FIN ED
INSPEC
/ Y" 4
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
a.
Final
Final
f
} BLOCKWALL APPROVALS
steel
POOLS - SPAS
ZI
Set Backs
Electric Bond
q�
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation/ILV
Gas Piping
Tas Test
Appliances
-
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
emp. Use of Power
_ t
Final
Utility Notice (Perm)
Final
COMMENTS:
09/20/2002 10:08 7605642329
FAIRWAYS ASSOCIATION
September 17, 2002
L.
Mr. Bill Simpkins
80515 Weiskopf Way
La Quinta, CA 92253
RE: Spa and BBQ
Dear Mr. Simpkins:
At the September 16 2002 Architectural/Landscape Committee meeting the plans you
----- -----
su xnitted fore spa and BBQ were approved with the following conditions%
•;• Verify that the gas stub was approved by the city
❖ Verify the intended use oFthe gas stub
If you have any questions, or if I can be of further help, please do not hesitate to contact
xne.
Sincerely,
41
ANACCIO, CMC.,
Aociatn Manager
DM/ncp
PAGE 02/02
Post Officc Box 1658 • La Quinta, California 92253 • Phone (760) 564 -3858 -Fax (760) 564-2329